MEDICARE: MS. AMANDA BARBUR AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	A.01821	OH

General Provider Information

NPI Number	:	1659629962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA BARBUR AU.D.

Provider Business Mailing Address
First Line	:	1701 MENTOR AVE
Second Line	:	SUITE 5
City	:	PAINESVILLE TWP
State	:	OH
Zip	:	44077
Country	:	US
Telephone Number	:	440-357-4327
Fax Number	:	440-357-4328

Provider Business Practice Location Address
First Line	:	1701 MENTOR AVE
Second Line	:	SUITE 5
City	:	PAINESVILLE TWP
State	:	OH
Zip	:	44077
Country	:	US
Telephone Number	:	440-357-4327
Fax Number	:	440-357-4328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	07/29/2020

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